Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative
Rapid implementation of virtual clinics due to COVID-19: report and early evaluation of a quality improvement initiative
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DOI：
10.1136/bmjoq-2020-000985
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发表时间：
2020-06-01
期刊：
影响因子：
1.4
通讯作者：
Bateson, John
中科院分区：
文献类型：
--
作者：
Gilbert, Anthony William;Billany, Joe C. T.;Bateson, John
背景新冠肺炎疫情给国家卫生服务体系带来了巨大的压力。英国于2020年3月引入了社交疏远措施，虚拟咨询(通过电话或视频通话)被确定为此时面对面咨询的潜在替代方案。当地问题皇家国家整形外科医院平均每月有11200次面对面咨询。平均而言，7%的邮件是通过电话发送的。为应对新冠肺炎危机，英国国立卫生研究院制定了一个目标，将面对面的就诊人次占所有门诊人次的比例降至20%。这份报告概述了一项质量改进倡议，以在RNOH快速实施虚拟会诊。方法组建了由医疗保健专业人员组成的多学科小组-新冠肺炎行动小组，以支持虚拟诊所的实施。采用计划-行动-研究-行动(PDSA)循环，遵循卫生保健改进协会的质量改进方法。在改进原则的基础上，进行了启用、流程重新设计、交付支持和评估的过程。结果按照设定的80%虚拟会诊的目标，87%的会诊在前6周内虚拟交付。虚拟会诊的满意度得分很高(患者为90/100，临床医生为78/100)；然而，在新冠肺炎大流行之外，视频会诊在不到50%的情况下是首选的。结论本报告表明，虚拟会诊可以快速响应新冠肺炎的需求，并且基本可以被接受。在COVID-19之后，还需要进一步的举措来支持临床上合适和可接受的虚拟会诊。注册本项目已提交给RNOH的项目评估小组，并于2020年3月12日被归类为服务评估(参考编号：SE20.09)。
Background The COVID-19 outbreak has placed the National Health Service under significant strain. Social distancing measures were introduced in the UK in March 2020 and virtual consultations (via telephone or video call) were identified as a potential alternative to face-to-face consultations at this time.Local problem The Royal National Orthopaedic Hospital (RNOH) sees on average 11200 face-to-face consultations a month. On average 7% of these are delivered virtually via telephone. In response to the COVID-19 crisis, the RNOH set a target of reducing face-to-face consultations to 20% of all outpatient attendances. This report outlines a quality improvement initiative to rapidly implement virtual consultations at the RNOH.Methods The COVID-19 Action Team, a multidisciplinary group of healthcare professionals, was assembled to support the implementation of virtual clinics. The Institute for Healthcare Improvement approach to quality improvement was followed using the Plan-Do-Study-Act (PDSA) cycle. A process of enablement, process redesign, delivery support and evaluation were carried out, underpinned by Improvement principles.Results Following the target of 80% virtual consultations being set, 87% of consultations were delivered virtually during the first 6weeks. Satisfaction scores were high for virtual consultations (90/100 for patients and 78/100 for clinicians); however, outside of the COVID-19 pandemic, video consultations would be preferred less than 50% of the time. Information to support the future redesign of outpatient services was collected.Conclusions This report demonstrates that virtual consultations can be rapidly implemented in response to COVID-19 and that they are largely acceptable. Further initiatives are required to support clinically appropriate and acceptable virtual consultations beyond COVID-19.Registration This project was submitted to the RNOH's Project Evaluation Panel and was classified as a service evaluation on 12 March 2020 (ref: SE20.09).